Antibiotic consumption in Italy.
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Biomedical subjects
Publications and source records attributed to C Grassi.
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The main theories concerning the pathogenesis of bronchospasm are cited and reference on is made to the part played by the respiratory physiopathology laboratory with respect to past or present patients with this symptom. Attention is then directed to the action of bronchodilatatory substances in the resolution of a proven state of bronchospasm. Administration modalities, techniques, parameters, and percent improvements considered as significant in the light of the literature data and personal experience are illustrated. Bronchoprovocation tests are briefly reviewed. These are divided into aspecific and specific, according to the mediator employed. The first group involve the action of distilled water, physical effort, F2alpha prostaglandins, acetylcholine, and propranolol. The second, which are much more delicate, less certain in their meaning, and not entirely risk-free, offer information of a general nature and impose the need for due care in their practical application.
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Following a review of the physiology of the subject, attention is concentrated on the significance of O2 consumption during exercise. The stages through which O2 passes prior to being used by the muscles are discussed, i.e. respiratory, cardiocirculatory, haematic, metabolic-tissue stages. Subsequently, the methods most commonly employed to evaluate the capacity of a patient to withstand an exercise test are illustrated and discussed. The various types of ergometers are covered first, the positive and negative features of each being indicated. The various tests are then described, these being subdivided according to their intensity into maximal and submaximal tests and, according to the load, into tests with constant load, increasing load, continuously growing load and variable load. The salient features of each are listed. The measurements (parameters, units, indices) that may be used and the standards to be observed on the basis of W.H.O. and EEC proposals are considered. After presenting the factors on the basis of which an exercise test may be appraised in relation to its purposes, the criteria for interpreting results in healthy and sick subjects are examined, with particular attention being paid to pneumo-patients and those with heart diseases. Particular stress is laid on the variations in certain basic parameters, such as Maximum withstandable effort, Oxygen debt, Maximum aerobic work, Ventilation break point and the behaviour of Haemogasanalytic, ECG, Cardiac output and Pulmonary artery pressure data in normal and pathological situations.
Physiological considerations relevant to a general understanding of the question are put forward and the main methods used for determining the ventilation-perufsion ratio are described. Over-all methods offer generic evaluation of a change, particularly the method whereby the alveolus/arterial PO2 gradient is measured on straight lines expressing the different points of gas and blood respiratory exchanges, and that which measures the triple CO2, O2 and N2 alveolus/arterial gradient. Methods employed to evaluate the distribution of ratio changes are also explained: evaluation with CO2 labelled with 15O2, 133Xe, 13N2 and 85Kr, using pairs of scintillators, scanning detectors, gamma camera or special cuvettes, and analysis of respiratory He, Ar, O2, CO2, N2O and CHF2Cl at the mouth and inside the lung, using rapid analysers and single or multiple breath methods, or analysis of gas elimination coefficients. It is felt that measurement of the VA:Qc ratio is now within the capacity of all laboratories, so that qualitative, semi-quantitative and quantitative assessment can be made not only of the ability to ensure efficient alveolar exchange on the part of ventilation and circumation, but also of the presence of compensated changes, or the simultaneous presence of other alterations of various kinds, which cannot be readily detected by using conventional methods.
This work deals with a modification of a thromboelastograph which enables to measure both in vitro and in vivo effectiveness of mucolytic substances. A simple method is described for building up a comparative diagram of the effectiveness of several drugs; a diagram which is of interest from both a pharmacological and a clinical point of view.
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In 69 out-patients with chronic bronchitis in 6 centres the effects of acetylcysteine 600 mg daily, 3 days a week for 6 months, and a placebo have been compared in a double-blind controlled trial. Thirty-five patients were treated with the mucolytic and 34 with the dummy preparation. In the former the clinical course of the chronic bronchitis improved to a greater extent and a significantly lower number of exacerbations was observed. The advantages of long-term oral treatment with the mucolytic in chronic bronchitis suggest that it may be useful as an alternative to long-term antibiotic prophylaxis, or to complement brief courses of antibiotics, in addition to the usual physiotherapy.
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A technique and an original apparatus for recording and displaying the sound levels emitted by human lungs during respiratory movements are described. By means of it a graphic recording of chest acoustics can be obtained. An analysis of the phonopneumographic findings shows clear differences between normal pathological readings, both in the level of the sounds and in their frequency content. Evidence is given of cases in which the physician can directly recognize the presence of special diseases. Beside this, FPGraphic representations are also useful for retaining evidence of findings which cannot be recorded by other methods, and for checking the natural evolution of a disease or its response to clinical treatments.
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The authors study the influence of acute and chronic ethanol intoxication on the blood levels of rifampicin and isoniazid as well of aminoglycoside antibiotics in rats. While the acute ethanol intoxication has no influence on blood levels of tested antibiotics, in the chronic inotoxication lower levels of rifampicin and higher levels of isoniazid are observed. A study was performed also to determine the influence of an acute and chronic treatment with alcohol and the avoe quoted antibiotics on the BSP elimination rate. In the acute as well as in the chronic experiments, a constant significant delay in the elimination of BSP was observed in animals treated with rafampicin either alone or associated with alcohol. Isoniazid modified the dye elimination in comparison to controls only in chronic experiments. Ethanol did not seem to have any influence on this behavior. The implications and the possible significance of these findings are discussed.
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